While group A streptococcal (GAS) bacteria is treated in an attempt to truncate the course of a treatable sore throat and reduce the complication of or association with rheumatic fever or glomerulonephritis, this is not the only cause of severe bacterial pharyngitis in adolescents and young adults.  Something more dangerous is lurking.

According an article published December 1, 2009 in the Annals of Internal Medicine, physicians also should be aware of  another, even more dangerous cause of acute pharyngitis: Fusobacterium necrophorum, especially when that throat worsens--strept-positive or negative.

F. necrophorum has been recognized as a potential cause of pharyngitis in in the past five years. It may cause up to 10% of 15-24 years old's sore throats.  Per Robert Centor, M.D. (Associate Dean of Medicine at UAB): It "is associated with a rare but life-threatening complication called Lemierre syndrome" that 1) mostly affects adolescents and young adults but is rarely seen in pre-adolescents. 2) 4-5 days after a sore throat, there may be unilateral neck swelling from an infected jugular vein and or 3) abscesses elsewhere. 4) Approximately 5% of people who get Lemierre syndrome can die from it.

"The risk of Lemierre syndrome exceeds the risk of acute rheumatic fever, which is the classic reason that physicians worry about sore throats."  There is no routine test for F. necrophorum pharyngitis.  Later a positive blood culture may be reveal the bacteria; a CT scan is usually required.  Aggressive treatment with antibiotics such as a combination of penicillin and metronidazole or with clindamycin alone is appropriate.